It’s an excellent question, and we put it to our friend Ann McKnight, a social worker and psychotherapist. Her answer might surprise you. If you feel like you’re not being heard, you might want to look at yourself first. “You have to ask yourself, ‘Is this really about me getting my way?’ If it is, you’re virtually guaranteed the conversation won’t go anywhere,” she says. “Most of the time, we engender defensiveness in the other person because of the way we say things.”

That defensiveness shuts down the opportunity for real communication, and the conversation ends before you’ve gotten to the issue, even if you’re still talking. That defensiveness is rooted in fear—fear of being judged, criticized, blamed, shamed, cut off. Just as fear interferes with our willingness to bring up difficult issues, it interferes with the other person’s willingness and even ability to really listen. Fear is the ultimate intimacy blocker.

Your genuine desire to understand what’s going on with the other person is critical to that person’s listening skills. Arriving and hanging onto that desire while you’re talking about a touchy subject isn’t easy, but it is possible.

Here are three things Ann says you can do to improve the chances that your beloved will be able to hear what you’re saying.

Be curious. That thing your loved one is doing? He or she is probably doing it for a good reason. “The conversation needs to be ‘There are clearly some things about this behavior that are working for you, so let’s talk about those.’ After you connect about those reasons, then you have a more interested audience. Repeat the reasons back in a nonjudgmental way, and then ask if the person is willing to hear what’s not working for you. If you can get to that place, then you have an opportunity for an open dialogue.”

Make sure you’re staying connected. “That means the other person is experiencing that I am in a place that’s open to hearing them. It doesn’t mean I have to agree. Only that I care if they are feeling judged and I care about their thoughts,” says Ann.

If the other person hears judgment or criticism or blame—even if you don’t think you’re conveying any of that—the connection will be lost. Increase your chances of maintaining the connection by, at the outset of the conversation, saying something like: “I have something to share with you and I’m not coming from a place of criticism [or blame or whatever], so if you could raise your hand when you’re feeling that, then I can reassure you in the moment or I can say, ‘You’re right. I am being critical.’”

Let go of the outcome. Finally, go into the conversation with absolutely no attachment to the outcome, and keep an open mind the entire time. Once you hear what it is about the other person’s behavior that is working for them, says Ann, “your attachment to ‘You need to stop this right now’ changes and you think, ‘Maybe, given what works for other person, there’s a different way to solve this.’”

Throughout the conversation, keep demonstrating to the other person that the conversation is not just about you getting your way. “You keep throwing them a lifeline by asking ‘What is it like for you to hear what I just said?’ That shows the person that you actually care about their response to what you’re saying.”

Throw that lifeline enough times and your partner just might start throwing it back to you. That’s not just a way to resolve a difficult issue—it’s also the way to increased intimacy.

July 27, 2015

“I just cannot talk to him about this!” I’ve heard that declaration from patients and friends alike over the years. Sometimes the “this” is something related to sex, but sometimes it’s related to issues that have festered—everything from “he doesn’t spend time with my side of the family” to “I always have to be the ‘bad cop’ to his ‘good cop’ with the kids.”

The topic itself doesn’t matter much because all topics come down to the same things: “Do you care about me? Can I trust you?” says Ann McKnight, an experienced social worker and psychotherapist in my community. “We want to tell ourselves it’s just about this one issue, whatever that is, but this issue is often sitting on top of other hurt that hasn’t been addressed.”

Intimacy is all about connection and trust. Deepening intimacy involves making yourself vulnerable. Being real. What makes it so difficult to talk about things that really matter? Ann says reasons vary. We might do it because we think we are being considerate of the other person. (“He’s under so much stress right now. The last thing he needs is another problem.”) We might not feel confident in our ability to navigate through the conversation. Or we might worry that the conversation will result in so much anger that the relationship will never recover. And the longer we don’t talk about the topic, the harder it becomes. The resulting resentment can erode even the best relationships.

But it’s actually the very things we try to avoid, like sensitive topics, that increase intimacy. Ann asks, “What would happen if we saw these conversations and the pain and anger that come up in them as an opportunity to learn something that might result in growing closer to each other?” While there are no guarantees, Ann has seen this happen over and over in her practice.

After you decide you want to bring up the issue (and you’re sure that you’re not expecting the conversation to lead to a change in behavior for the other person) then you’re ready for the conversation. You might start by saying something like, “Our relationship is so very important to me that I’m willing to risk feeling uncomfortable right now to work on strengthening it. I’d love to know more about what ____[issue] is like for you. Would you be willing to talk with me about this? When would be a good time?” In some cases, you might want a therapist to act as facilitator.

While such conversations are painful, they are also necessary. How can your partner respond if you haven’t shared what’s going on? “If we are not bringing ourselves forward to be known and seen and cared about, it’s easy to tell ourselves we are not lovable to others,” Ann says. “But when we take that risk with people who hang in there, the rewards can be huge. It can be freeing and it can help people shift out of places that seem impossible to get out of.”

The subtitle says it all. The co-authors, Pepper Schwartz and Janet Lever, are PhDs and sex experts. They’ve put a huge amount of thought and research into a book crammed with irresistible ways to foster romance.

They list getaways to suit every taste—cities, natural beauty, beaches, and adventure; on every continent—well, maybe not Antarctica. A random sampling: the Great Barrier Reef, the Loire Valley, the Amalfi Coast, Marrakech, Bali, the Cotswolds. Detailed listings for each destination make planning that much easier.

The hardest part might be deciding where to go. Schwartz and Lever suggest having both partners list the three places they most long to see. With luck, the two lists will share at least one destination.

The authors acknowledge, “Keeping romance—and passion—alive over the long term isn’t impossible, but it isn’t easy, either. It’s complicated: We crave the security that comes with our committed relationship, but we also desire adventure and fresh discovery.” Traveling, including the planning and anticipation beforehand and the shared memories afterward, restores the excitement a relationship had when it was new.

Couples who share a long history are inevitably liable to “hedonic adaption”: getting so used to good things that they don’t feel good anymore. When traveling, couples encounter one surprise after another. Novelty makes the two more interesting to themselves and to each other. The authors write, “Research shows that the very best way for couples to refresh their love for one another is to do something, anything, novel together.”

Uninterrupted time away from day-to-day obligations means a chance to get to know a partner more deeply. Learning new skills, like kayaking or navigating an unfamiliar transit system, enhances mutual respect. According to the authors, a magnificent natural view “can ignite all four of the so-called love hormones: dopamine, which fosters feelings of love; oxytocin, which helps create trust and bonding, serotonin, which increases feelings of pleasure and well being; and norepinephrine, which gives us energy and is part of our sexual arousal.”

Inspired to start dreaming? Some promising websites are Travel.AARP.org, Frommers.com, PeterGreenberg.com, and SmarterTravel.com. AARP membership includes discounts for those 50 and older. Road Scholar (formerly Elderhostel), a nonprofit, offers educational adventures all over (including Antarctica). The Golden Age Passport, for those 62 and up, gives lifetime free admission to all U.S. national parks for only $10. For those 50 and older who would like to try swapping housing with other travelers, there’s also SeniorsHomeExchange.

But you don’t have to look across the world for new experiences to share. A day trip or a weekend trip can get you there—or even a trip to your bedroom!

March 24, 2015

A recent Wall Street Journal headline read, “Sex in Old Age May Lead to a Sharper Mind.” The article describes a study in which Dutch researchers looked into the way cognitive function and attitudes toward sexuality might be related among older people. Nearly 2,000 adults, with an average age of 71, were given a variety of cognitive tests. They were also asked a series of questions about sex—whether it was important for older people generally or themselves personally, whether they found it pleasant or unpleasant. They were asked whether they still benefited from intimacy and touching.

Quite a few—41 percent—said that their current sexuality wasn’t important, but 42 percent said it was important for older people in general. A quarter considered sex important or very important. Only 6 percent found sexual activity unpleasant. More than two-thirds believed that intimacy and touching were still vital.

The results of these questions and the cognitive tests were correlated. Both men and women who thought sex was important and were satisfied with their current sex lives tended to do better on the cognitive tests.

The Wall Street Journal article points out that the study made no claim that sex improves brain function, or vice versa: only that the two are associated. It can be difficult to disentangle cause and effect.

Another study looked at how cognitive function affects sexual behavior interest and sexual behavior among the elderly. The 352 Italians studied were between 65 and 105 years old. They were asked, “Are you interested in sex?” and “Do you have sexual relations?” They were also given two tests of cognitive functioning. One third were still having sex and 40 percent were still interested. This study suggested that a sharper mind might help keep a sex life going.

It could be that older people who are healthy enough to have sex are also healthy enough to do well on cognitive tests. Generally, whatever is good for the brain is also good for sex. That’s a good reason to keep on exercising, or to start.

February 26, 2015

A heart attack, whether it’s your partner’s or your own, is a devastating challenge for any couple. Recovery may be slow. Anxiety and fear are inescapable. Depression is common. The partner who is suddenly thrust into the role of caregiver may, at times, feel overwhelmed. Amid so many physical and emotional challenges, sex may feel like a low priority.

But it shouldn’t. What both of you need most of all is comforting, and nothing comforts like the touch of the one you love.

Both partners may be afraid of risking a recurrence. Not knowing what to do, they wait. Sadly, most are not getting appropriate advice from their doctors. In a recent study of patients aged 55 or younger, only 12 percent of the women and 19 percent of the men talked to their doctors about sex, and patients were more likely than doctors to bring it up (and I'd wager the numbers grow smaller with older patients). As one man said, “The subject was never mentioned in ten weeks of after-care sessions for life style and food advice and recuperative gym exercises.”

When sex did get talked about, two-thirds of the doctors gave advice that was more restrictive than the American Heart Association guidelines. Jalees Rehman writes, “The kind of restrictions recommended by doctors in the study—and presumably by medical practitioners who weren’t polled—are not backed up by science and place an unnecessary burden on a patient’s personal life.”

Blanket restrictions are unreasonable because every patient and every heart attack is different. It’s vital to discuss with your doctor your case in particular. After an uncomplicated heart attack, one week may be long enough to wait. Or you may need longer. The important thing is to be guided by where you are in your recovery.

Having sex is like doing mild to moderate exercise. If your doctor gives you the okay—and ask if he or she doesn’t give you the answers you need!—and if you can handle such activities as climbing stairs and carrying groceries without chest pain or feeling out of breath, sex should be fine as well.

You will be adjusting to new medications. Antidepressants may lower libido, and beta-blockers may interfere with erections. If you’re in open communication with your doctor about sexual issues, dosages may be adjusted or medications switched.

Various stressors are unavoidable, but sex can relieve stress and soothe both patients and their partners. The years of cultivating awareness of your own and your partner’s body will pay off. Care in tending to your relationship in the years before a crisis is like money in the bank. You never know when you might need it.

Sex is exercise, and exercise strengthens heart muscle. Sex also strengthens relationships. It’s a medicine no couple should be without for long.

November 27, 2014

Looking for a warm and cuddly holiday season? Try a little oxytocin spritz along with the turkey.

Oxytocin is a hormone produced by the pituitary gland that activates certain reward receptors in the brain. It makes people compassionate. It makes women love their babies. It’s released during orgasm and causes couples to feel close to one another, thus its nickname, “the cuddle drug.” It’s also involved in addictive behavior, along with dopamine, another “feel-good” neurotransmitter.

A couple of recent experiments by Dr. Rene Hurlemann at the Bonn University Medical Center, however, suggest that oxytocin is a hormone that keeps men monogamous. Contrary to all kinds of evolutionary thinking, which would suggest that men would be driven to spread their seed in all directions, oxytocin appears to increase a man’s attachment to his sexual partner.

Monogamy is rare in the mammalian world. Only 3 to 5 percent of warm-blooded creatures pair up for life.

In his first experiment, Dr. Hurlemann spritzed a few men with oxytocin and then introduced them to an attractive woman. The men in monogamous relationships stayed 6.5 inches farther away, on average, from the woman than single men did. When the same partnered men weren’t spritzed, the extra distance disappeared.

Dr. Hurlemann decided to investigate further.

In his second experiment, the male subjects, who were all in permanent relationships, were hooked up to a brain scan. First, they were spritzed with oxytocin, and then they were shown photos of their partner, of other attractive women, and of female acquaintances.

Sure enough. The parts of the brain associated with reward (the nucleus accumbens) and motivation (ventral tegmental area) lit up at photos of the partner, but not at the strangers or at female acquaintances. Under the amorous effect of oxytocin, these guys also felt that their partners were more attractive than photos of the other women.

The researchers hypothesize that this hormone that is released during close physical contact and that tickles our pleasure center reinforces monogamy this way: A man may limit the spread of his genes by sticking with one partner, evolutionarily speaking. But by sticking around to create a stable environment and helping to rear his offspring, he increases the likelihood that they will survive to reproduce. So, rather than feckless promiscuity, evolution takes a different tack and oxytocin is the carrot.

And while that’s a cold, scientific view of the situation, lots of touching, cuddling, massaging, and good old sex will keep your man’s pleasure centers (as well as your own) well-lubed and attached to the source of the goodies! In Dr. Hurlemann’s research, even the close presence of the partner was enough to release oxytocin, giving new meaning to the saying, “stand by your man.”

While you’re basting that turkey, keep in mind that our traditional holiday fowl is also high in dopamine, which might be well-poised to edge out Valentine’s Day (even in spite of the afternoon football) as the season of love.

November 25, 2014

I don’t know about you, but I care about a lot of things: my profession, my daughters, my friends, my community, my church. Because I care about them, I carve out time for them. My calendar is full, and so is my husband’s with the things he cares about. Often, our respective calendars send us in different directions.

When you’ve been together as long as we have, it’s easy to take each other for granted. We can forget to make time for the one you care most about—each other. We’ve talked before about the importance of putting sex on the calendar if you want better sex, and the same is true of intimacy (yes, there’s a difference). To maintain—and deepen—your connection to each other, you need to set aside time in which you focus on each other and have fun together.

How you spend your date night is up to the two of you to decide, and that’s half the fun. I highly recommend that you try something different as a way of avoiding something called “habituation.” New things stimulate the mind, but over time the newness wears off and they become less and less engaging.

That’s habituation, and it’s not great for a marriage.

Date night is an opportunity to continually introduce the new and keep your relationship interesting. Attend a concert, take a class (cooking, art appreciation, Italian), or learn a new sport together. If money is tight, try one of these ideas:

Take the dog for a walk together, and let the dog determine the route

Go to a pool hall and play a game of pool

Dance to music that was popular when you first met

Go to the bookstore and pick out books for each other (no need to buy; the fun comes in talking about why you chose the books you did)

Regardless of what you choose, try to build in some time to talk either before or after the event. You’ll be surprised at how changing up the scenery and your activities will also change the nature of your conversation.

Date night creates a lovely cycle, really. Spending quality time together increases intimacy, which sets the stage for better sex, which further increases intimacy. So compare calendars and pencil in date night for the next six months. We’d love to hear what you choose!

November 17, 2014

When I read the results of a new study showing that couples who watch and then discuss movies about relationships could reduce the likelihood they would divorce, it occurred to me that watching movies that include sex scenes might have a similarly positive effect on one’s sex life.

Friend, it does, and the reason is simple. Sitting down and watching a movie together on any topic—be it global warming, relationships, or sex—creates mindshare for that topic. And when it comes to sex, once you’ve created mindshare, the rest often takes care of itself.

We’ve talked about movies before, and our difficulty in finding them. I’ve been pressed for time the last month or so, so I asked a friend for some recommendations to pass along. She did some research—and a lot of movie-watching—on our behalf and recommends these three movies—movies with real storylines, acting, cinematography, and sex scenes that spring organically from the plot—guaranteed to remind you and your significant other that each of you are not only a spouse, parent, child, employee, or committee chair, but also a lover. (The comments are hers, but she also helpfully included links to New York Times reviews if you’d like confirmation!)

Julio and Tenoch, teenage boys in Mexico, can’t believe their luck when Luisa, a (slightly) older woman, agrees on a whim to go on a road trip with them to find a beach. Carnal relations ensue, some more surprising than others, but so does self-awareness. If, at the outset, the movie feels like a Mexican American Pie (the first sex scene occurs 20 seconds in, and the boys have a manifesto that includes “do whatever you feel like” and “don’t marry a virgin”), don’t be discouraged. It gets better. Luisa eventually tires of their immaturity and makes the rules, which the boys agree to follow. Her own manifesto includes “I pick the music,” “You cook,” and “You’re not allowed to contradict me.” Now that’s sexy! And there is a secondary storyline that hints at Mexico’s political and economic landscape seen from the car windows as the threesome cross the country. Sexy, funny, sad, and smart.

This movie had me at the premise: Lorenzo is a writer; Lucía is an avid fan. She tracks him down, says she loves him and his novel, and moves in with him that same night. “I always liked people who tell good stories,” she says. “I trust them.” But should she? Lorenzo has a complicated past, and he’s also writing another novel; in the movie, you can’t always tell whether a scene is real or one he’s writing for his novel. No matter. Just enjoy the ride, particularly during the sweet and explicit (yes, both!) photo shoot L&L do together at 28 minutes, and a sexy (Lucía’s) and funny (Lorenzo’s) strip tease a few minutes later. A person might pause the movie there and get down to business with the one you’re with. Later you can resume the film, which gets a good deal darker, and try to untangle fact from fiction over a nice glass of wine.

French Indochina, 1929, is the setting for this story about forbidden love between a French teenager from a dysfunctional family and a wealthy Chinese man who is besotted with her—but betrothed to another. The plot unfolds in a leisurely fashion, giving the story time to build. Looks are exchanged and fingers are tentatively touched, before they give in, but oh, when they do (38 minutes in for about 10 minutes), it’s a beautiful, aesthetically pleasing thing. The lovers are doomed, of course, but until the day of reckoning, they escape their own pain and inflict (primarily emotional) pain on each other. As with Sex and Lucía, to avoid having the plot spoil the mood, pursue your own agenda whenever you’re ready (if not by the 54-minute mark, then certainly after).

In fact, that’s good advice for watching any of these movies. Act now (and now, and ohhh, now); discuss later. According to research, both are good for your relationship.

And we’re always happy to hear from you about movies that stoke your flames!

May 02, 2014

Perhaps you’ve seen reviews of a new book, called Sex After…: Women Share How Intimacy Changes as Life Changes. It’s definitely in my reading pile. The author, Iris Krasnow, interviewed 150 women from 20 to 90 about their sex lives.

The surprise—to Iris and some reviewers—was that the women in the later chapters were claiming some of the best sex of their lives. Among the comments:

We are so comfortable with each other that we will try anything to keep things hot.

When you’re younger, it’s all about the orgasm, then it’s over. I love this suspended feeling, the absolute intimacy we have been able to achieve.

Given my conversations with patients in my practice, I’m not surprised. There’s a whole lot of life after 50, and a whole lot of pleasure.

Two things typically get in our way: First, just as our kids never wanted to know we had sex (mine are adults and still don’t want to know!), we’re culturally just a little uneasy with grandparents having sex. Silly, but there it is.

And second, we could do a better job of sharing information about how to keep sex comfortable for just as long as we want it—and expanding our thinking about what “sex” means as intimacy beyond vaginal intercourse.

Most of the women I see are interested in being sexually active—I am, after all, a gynecologist. Every now and then, though, a woman will tell me, “We’re done with all that. And it’s okay.”

I think it’s awfully hard to tease out how we really feel about that “okay”: If it’s not cultural messages that we’re too old for sex, it's a cultural message that we need to keep at it to stay young. For many of us, the discomfort we may now experience with sex is enough to sway us toward that “too old” message.

But beyond the effect on relationships I’ve talked about before, what I hear from the women in this book echoes my own experience: Sex is part of feeling alive, powerful, energized, secure, blissed, refreshed. I’ll decide for myself when I’m ready to give that up.

And you can, too.

April 14, 2014

Let's first acknowledge that women—and men, too—come to sex with a host of different backgrounds, value sets, cultural expectations, emotional foundations, and experiences. It's very difficult, given that variety, to assert that anything is or should be true for every woman.

It is theoretically possible to have a strong physical attraction and enjoy sex with little emotional intimacy involved—whether we are men or women. There are differences between us, though: Research suggests that for women there are six neurotransmitters involved in sexual activity, and that the areas that "light up" in our brains with sex are completely different from men's responses. Women release oxytocin with sex, a very strong bonding hormone; men don't.

Cultural stereotypes may exaggerate the differences between men and women when it comes to sex, but the science is there to prove there are differences.

Among the women in my practice and in the rest of life, I observe that women often go into sexual experiences with an expected outcome that includes some emotional connection. Most of the women I see desire emotional intimacy as a cornerstone for their enjoyment of physical intimacy. And the study I recall that went the furthest in qualifying sexual enjoyment ("A Portrait of Great Sex") implied emotional intimacy as intertwined with physical intimacy.

All of that said, I come back to the fact that women come to sex with enormous variety of experience and expectation. As long as she is caring for her own emotional and physical safety and health, each woman can choose, I hope, the right combination of emotional and physical intimacy.